Provider Demographics
NPI:1326017674
Name:BARKER, ROSILEE W (PA C)
Entity Type:Individual
Prefix:
First Name:ROSILEE
Middle Name:W
Last Name:BARKER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:ROSILEE
Other - Middle Name:W
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6901 N 72ND ST
Mailing Address - Street 2:SUITE 3300N
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122
Mailing Address - Country:US
Mailing Address - Phone:402-572-3300
Mailing Address - Fax:402-572-3305
Practice Address - Street 1:6901 N 72ND ST
Practice Address - Street 2:SUITE 3300N
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122
Practice Address - Country:US
Practice Address - Phone:402-572-3300
Practice Address - Fax:402-572-3305
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q34431Medicare UPIN
278552Medicare ID - Type Unspecified